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Home My WebLink AboutBLD-93-594 to: '�o . TOWN OF YARMOUTH of<r,.d g/4/ , . o •-y; • ;TAG HEC �% ,, .ted,.- Application forG � a Permit to Build No. UPON FINAL APPROVAL J g' ' ' 3 MAP et LOT 1--t2 FEE MUST ACCOMPANY THIS APPLICATION. DATE a ar . The undersigned hereby applies for a permit to build /aP. according to the following specifications a /09.3 1-1:-Nitme of property owner Dorothy P. Smith TeL 362-6171 Address 32 Seminole Drive, Yarmouth Port MA 02675 2.Name of Architect(if any) Tel. C-3:Name of builder C u,r/ira Address same 4. License No. Tel. 5. Name of Mason Address 6. License No. Tel. Construction address 32 Seminole Drive, Yarmouth Port Flood District WO 8. Date of subdivision Approval plain zone /3 Zone 9. Private dwelling 0 �stimated Cost "�U�' DO WRITTE IN THIS SPACE g_,�-�3 .�� qc. Type of room No. 10. Multi family 0 70r1 r SA/fir 11. Commercial 0 i/s-0 a. /O, coo bj, Kitchen 12. Other /)\-90-Pete-----, ( rej< Dining Rm. C$'AHE Living Am. 13. No. of stories �� Bed Rm. 14. Foundation — Full 0 Half 0 Crawl ❑ Slab 0 /0 , o-o- Bath 15. Materials — Wood 0 Cement 0 Other 0 Deck Q t 16. Type of heat — Oil 0 Gas 0 Electric 0 Other 0 a Closed p" orch 17. Garage — 1 0 2 ❑ Family Rm.Sun room 18. Swimming pool - Size Garage 19. Storage shed — Size Shed 20. Stove —Wood 0 Coal 0 Alterations 21. Size of lot: No. of feet front No. of feet rear No. of feet deep 22. Size of building. No. of feet front No. of feet side No. of feet rear 23. Distance from nearest building: Front Ft. side Ft. side Rear 24. Distance back from line or street From rear lot line Side line 25. H.I.C.R. No. LOT RELEASED BY Signature / eri� Ms PLANNING BOARD ""'Address 32 Seminole Drive Datet '- Yarmouth Port VA 02675 V APPLICANT: Dorothy P. Smith BUILDING PERMIT I7: tDPESS: 32 Seminole Pr Yarmouth Port TELE. NO. : 362-6171 DATE FILED: /y4/3 uiLDG. SITE LOCATION: 32 Seminole Dr. MAP$: . / LOT/f: 2-5,2 THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD, ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER- MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD . PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSMITG , 'HE APPLICANT THOUGH THE FOLLOWING DEPARTMENTS: irk RESIDENTIAL AND/OR COPPIERCIAL BUILDING • WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY. ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE. , CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, I.E. : IF LOT(S) BORDER ANY TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH LAND, ETC. HEALTH-DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E. : REQUIRE- MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES. FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL SAFETY, PROPERTY PROTECTION, I.E. , SMOKE DETECTORS, SPRINKLER SYSTEMS ETC. THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR ISSUING THE REQUIRED BUILDING PERMIT: REVIEWED BY: 1. WATER DEPARTMENT DATE: N/A: 2. ENGINEERING DEPAt MENT: DATE: N/A: L3. HEALTRVDEIAR: / r/ DATE: S,y-q3 N/A: (fit. HEALTH DEPART 7'� � I lUSTrLAL AND/OR COMMERCIAL PERMITS 5. WIRING INSPECTOR: DATE: N/A: 6. PLUMBING INSPECTOR: DATE: N/A: 7. FIRE DEPARTMENT: DATE: N/A: PLEASE NOTE ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING PERMIT. n/J � COMMENTS: ( �/�ey/Sen/444 n e a h/O/�C e fer , cY o i c 67.4^9lrre/ . "`�/� 7% BLM/89 . COMMONWEALTH OF MASSACHUSETTS 17 DEPARTMENT OF INDUSTRIAL ACCIDENTS >-� 600 WASHINGTON STREET • . James Gampoee BOSTON, MASSACHUSLI IS 02111 • r ornmasionr • 171, WORKERS' COMPENSATION INSURANCE AFFIDAVIT • • I' , '" Dorothy P.:Smith - (licensee/perminec) • with a principal place of business/residence a • itan // 32 Seminole Drive, Yarmouth Port MA 02675 ��/// (Ci ry/S urn/Zip) . do hereby certify, under the pains and penalties of perjury, that: ft.:. f] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number 1 am a sole proprietor and have no one working for me. ( J I am a sole proprietor, genenil contractor r homcowne (circle one) and have hired the contractors listed below who have the following workers' compensation in policies: Name of Contractor • . Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Numb:: r , X I am a homeowner performing all the work myself. • NOTE.:_Melte be aware that while homeowners who employ persoos to do maintenance, construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally considered to be employers under the'workers' Compensation Aa(GL C. 152,sect. 1(5)), application by a homeowner for a license or permit may evidence the local sums of an employer under the Workers' Compensation Act. I under::and that : copy oft his statement will be forwarded to the Department of Industrial Acddcnts' Office of insur.nc for coverage vcrnc::on and thy failure to islure covcre e u recuired under Se^on 25A'of MC.. 152 cti lead to the imposition of criminal penaldes ccnsiscnc of: line of up to 51500.00 andfor imprisonment of up to one year and civil pcnaides in the form of a St::Work Order and 2 fine of 5100.00 a day azains:me. z !/`cr_d :hi /i�—Carol 19n / Asia, ;.4. 0:..r/i...st r • TOWN OF YAMOUTII BUILDING DEPARTMENT HOMEOWNER LICENSE . a s TION PLEASE PRINT: ` ATE a7 %/ 1993 /AVB LOCATION 32 Seminole Drive Yarmouth Port "" . . NUMBER STREET ADDRESS SECTION OF;TOWN c- 1&MEOWNER" Dorothy P. Smith 362-6171 N/A NAME HOME PHONE WORK PHONE ENT MAILING ADRESS 32 Seminole Drive. Yarmouth Port MA 02675 Yarmouth Port MA 02675 CITY OR TOWN STATE ZIP CODE THE CURRENT EXE`R'TION FOR "HOMEOWNER" WAS EXTENDED TO INCLUDE OWNER-OCCUPIED • DWELLINGS OF SIX UNITS OR LESS AND TO ALLOW SUCH HOMEOWNERS TO ENGAGE AN IN- DIVIDUAL FOR HIRE WHO DOES NOT POSSESS A LICENSE, PROVIDED THAT THE OWNER ACTS AS SUPERVISOR. (STATE BUILDING CODE SECTION 109.1.1) DEFINITION OF HOMEOWNER: PERSON(S) WHO OWNS A PARCEL OF LAND ON WHICH HE/SHE RESIDES OR INTENDS TO RE- SIDE, ON WHICH THERE IS, OR IS INTENDED TO BE A ONE TO SIX FAMILY DWELLING, ATTACHED OR DETACHED STRUCTURES ACCESSORY TO SUCH USE AND/OR FARM STRUCTURES. A PERSON WHO CONSTRUCTS MORE TITAN ONE HOME IN A NO-YEAR PERIOD SHALL NOT BE CONSIDERED A HOMEOWNER. SUCH "HOMEOWNER" SHALL SUBMIT TO THE BUILDING OFFICIAL, ON A FORM ACCEPTABLE TO THE BUILDING OFFICIAL, THAT HE/SHE SHALL BE RESPONSIBLE FOR ALL SUCH WORK PERFORMED UNDER THE BUILDING PERMIT. (SECTION 109.1.1) THE UNDERSIGNED "HOMEOWNER" ASSUMES RESPONSIBILITY FOR COMPLIANCE WITH THE STATE BUILDING CODE AND OTHER APPLICABLE CODES, BY-LAWS, RULES AND REGULATIONS. THE UNDERSIGNED "HOMEOWNER" CERTIFIES THAT HE/SHE UNDERSTANDS THE TOWN OF YARMOUTH BUILDING DEPARTMENT MINIMUM INSPECTION PROCEDURES AND REQUIREMENTS AND THAT HE/SHE WILL COMPLY WITH SAID PROCEDURES AND REQUIREMENTS. . Y A6'EOWNER'S SIGNATURE .41 v frirnie APPROVAL OF BUILDING OFFICIAL NOTE: THREE FAMILY DWELLINGS 35,000 CUBIC FEET, OR LARGER, WILL BE REQUIRED TO COMPLY WITH STATE BUILDING CODE SECTION 127.0, CONSTRUCTION CONTROL. INSURANCE COVERAGE: I have a curren' liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes No ❑ If you hav ch _keds, please indicate the type coverage by checking the appropriate box. A liability Insurance policy rid Other type of indemnity 0 Bond 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 cf the Mass. General Laws, and that my signature on this permit application waives this requirement. i /&fliti �r4 — r ,. , Check one: Owner. Agent ❑ Signature of Owner or era s ent __ _ PLOT PLAN • FOR LOT n • Indicate locate cf garage or accessory building • Additons with dashed lines Sewerage disposal (cesspool ) a Well 0 I (lot ft. rear) I — — — — w i� i� — — 0 \ - - vamethr's I • •• ) Abuttor's kbuLot ff ji.!!� Name p ,. Lot # REAR YARD l� #1"./40,40D :f this is a If this is orner lot, 1 ft. .,,... corner to 'trite in name •/fir •I-_ write in ,f street. I ` _ name of L I 1 to ,' c. other ti I / s street. it • SIDE YARD cent?� YA. ., /. F.-,.... _ ,{ •I HOUSE _ Y • 0 _ _ f� Y I LI -ICT c I • �4 SET BACK o I n• p I -Ce ^ Oct f` ftcntace) - • \ , / v' 32 Seminole Drive, Yarmouth Port \ \ 1/ / (NAME OF STREET) Suggeited Affidavit for Home Improvement Contractor Permit Application For min Use Only NAME OF CITY/TOWN Permit No. Date AI FIUAVIT Home Improvement Contractor Law Supplement to Permit Application MGL e142A requires that the"reconstruction,alteration.renovation,repair,modernization,conversion,inprnvement,removal,demolition. or construction of an addition to any pre-existing owner-occupied building containingat least one but not more than four dwelling umts....or to structures which are adjacent to such residence or building"be done by registered contractors,with certain exceptions,along with other requirements. 1/4— Type of Work: Acid ,/ , S � peR St2fr Est. Costo a6, ddress of Work 32 Seminole Drive, Yarmouth Port MA 02675 owner Name: Dorothy P. Smith i/b-ite of Permit Application: 7, /773 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law _Job under 51,000 Building not owner-occupied Owner pulling own permit _Other (specify) • Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ' ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: • Notwithstanding the above notice, I hereby apply for a perm't as the owner of the above property: catt Dae Owner Na , • •_/:- w y hit no•tfill 1 "c' (II < I;9/ • ) 0 \I . • •:. -`• i I, -*I . dil i f . . 1 ; 1 I i 1 til I , .1.• 1 C•O \le -11—C—gr ....- . -4 s a oH J I i /12/, ----5(---? . ivolizz.,•-:_./L-441 . . . . .______. I 1 . 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